Monday Medical

We may not like to talk about it or even admit it to ourselves. As Benjamin Franklin wrote in 1789, “In this world nothing can be said to be certain, except death and taxes.” He’s still right about death.

Every medical study ever conducted about the subject has concluded that 100 percent of Americans eventually will die. The Boy Scouts remind us to “be prepared,” but what does that mean for dying?

There are many answers: practical, spiritual and personal. Some are entirely unique, and others are fairly common among us.

Many of us are concerned about bankrupting our family with “too much” medical care. Many of us want to spare our friends and family conflict and heartache of having to guess what medical care we would have wanted. Some of us place top priority on dying peacefully, without pain, at home surrounded by family and friends. Others want to do everything, to fight for life above all else, to make it to that graduation, wedding or anniversary; no matter how painful or undignified the journey.

Less than 10 percent of us will die suddenly. Ninety percent will die one day at a time, with a multitude of medical choices to be made along the way.

As Americans, we treasure our personal freedoms, yet less than one-third of us have created an advance medical directive. We have the freedom to choose what medical care we want to receive and to name a person to speak for us if we cannot.

Two types of advance medical directives are a health care power of attorney and a living will. A health care power of attorney designates someone to communicate medical decisions for you if you cannot. A living will specifies your choices for medical care in specific situations.

I’m too young and healthy to need a medical directive, right? It is true that older people more often have advance medical directives, but every person age 18 and older should have one.

Younger adults actually have more at stake because, if stricken by serious disease or accident, medical technology may keep them alive but insentient for decades. Some of the most well-known “right to die” cases arose from the experiences of young people (e.g., Karen Ann Quinlan, Nancy Cruzan) incapacitated by tragic illnesses or car accidents and maintained on life support.

What happens in Colorado if someone does not have an advance medical directive and cannot communicate their medical choices? You may be surprised to learn that there is no default hierarchy. Spouses, children, parents and siblings are not given the power to make decisions as they are in some other states.

In Colorado, the patient’s attending physician attempts to assemble a group of interested persons (friends and family) and encourages them to agree on a proxy decision maker for the patient. If they cannot unanimously agree, a court order is needed to appoint a guardian.

This process can be fraught with emotion and delay. Meanwhile, the medical team applies its best judgment, knowing much about medical procedures and probable statistical outcomes, perhaps without the knowledge of who the patient is and what they value.

It is up to you. You have the power. This unfortunate situation can be avoided easily if you prepare an advance medical directive now, before you need it.

Advance medical directives don’t just apply in end-of-life situations. In an emergency, an advance medical directive can help the doctors on the scene get access to a patient’s medical history, save time and money on testing and speed surgical decisions or other life-saving care.

This article includes information from www.endoflifenorthwestern.edu, End of Life in America: A Historical Overview; Completion of Advance Directives Among U.S Consumers; and the American Journal of Preventive Medicine, Volume 46.

Catherine Swan, Esq., is a partner at Swan Law PC and a member of the Yampa Valley Medical Center Ethics Committee. She can be reached at catherine@swanlawoffice.com.